| Payment ID | 11912 |
|---|---|
| Date Created | 11/21/22 10:59 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 5378 |
| Authorization Number | |
| Applicant Information | |
| Name | Christopher Cline |
| Agency Name | Homeless Coalition |
| Agency Code | 220213 |
| Agency | Homeless Coalition |
| Agency Email Address | Email hidden; Javascript is required. |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171100496 |
| Payment Type | Security Deposits, Pet Deposits and App Fees |
| Payment Details | |
| Receipt Amount | $35.00 |
| Receipt Date | 11/18/2022 |
| Comments | application fee to Casa West paid on 11/18/2022 |
| Receipt | 18-11-2022-16171100496-Cline-35.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 11/21/2022 |
